Steeldust Farm & Pemi Valley 4-H River Riders
Entry Form
Rider Name_____________________________Age Jan. 1st_________
Mailing Address____________________________________________
Horses Name______________________________________________
Horses Owner______________________________________________
Date of Show Entering_______________________________________
Classes Entered
(please circle all classes you are entering)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Pre-Entered and paid (per horse and rider combination) $6.00 per class
_______
Must be received one week before show entering
Post Entry
# of classes entered____x$8. _______
Refundable Number Deposit
____x$1. _______
( )Check#_________
( )Cash Total Enclosed
Please make checks payable to Steeldust Farm
Mail to: Steeldust Farm 82 NH Rt. 175, Campton, NH 03223
_______
Release Form
Steeldust Farm or the Pemi Valley 4-H River Riders will not be responsible for any loss,
damage, or injury to horses exhibited or for any article of any kind or nature that may be
lost or destroyed or in any was injured. Each exhibitor will be responsible for any injury
that may be occasioned to any person, whomever, by any horse owned or exhibited by
him/her, and shall indemnify Steeldust Farm or The PemiValley 4-H River Riders against
all claims or demands or any kind or nature, that may grow out of any injury occasioned
by any horses owned or exhibited by him/her or arise from the negligence of the person
in charge of any such horse. All horses exhibited at this show will be entirely at the
owner’s risk. Steeldust Farm or the Pemi-Valley 4-H River Riders will not be
responsible or liable for any injury sustained in any way to exhibitors, spectators,
volunteers, and employees. All exhibitors under 18 must wear an ASTM Approved
Helmet.
All exhibitors in all jumping classes will wear an ASTM Approved Helmet
Signature of Rider_______________________________Date________
Signature of Parent Gaurdian if Rider is under 18___________________